Questions 89-102: Genetics and pediatrics

QUESTION 89

A 5-year-old child is being seen by his pediatrician because his parents are concerned regarding his behavior during his first year of school. They are concerned that he has autism. Physical examination reveals large ears and large testicles. Of the following, what type of mutation or chromosomal abnormality underlines this child’s condition?

A. Point mutation
B. Frameshift mutation
C. Trinucleotide repeat
D. A trisomy
E. A monosomy

QUESTION 90

A 19-year-old male who plays basketball for his college team is found dead in his dorm room by his roommate. He had an older brother who required a valve replacement and procedure on his aorta two years ago. Autopsy reveals an aortic dissection. A mutated gene for which of the following proteins was the most likely cause of his condition?

A. Elastin
B. Fibrillin
C. Keratin
D. Dystrophin
E. Titan

QUESTION 91

A 25-year-old male suddenly becomes short of breath while watching television with friends. Shortly thereafter, he becomes unresponsive. An ambulance is called, but, upon arrival at the emergency room, he is pronounced dead. Autopsy identifies an aortic dissection as the cause of death. The pathologist makes a diagnosis of Marfan syndrome. Which of the following features might also be expected to occur in association with this condition?

A. Short fingers
B. Pes anserinus
C. Colonic adenocarcinoma
D. Hemorrhoids
E. Kyphoscoliosis

QUESTION 92

Molecular analysis of a 10-year-old female, who was identified to have severe scoliosis, reveals a mutation in the gene for lysyl hydroxylase. Neither of her parents have a similar condition. Assuming L is for the normal allele and l is for the mutant allele, of the following, which combination best describes her parent’s genotype?

A. Father: LL; mother ll
B. Father: Ll; mother Ll
C. Father: LL; mother Ll
D. Father: LL; mother LL

QUESTION 93

A 24-year-old male is playing basketball with friends when he suddenly develops chest pain. His friends drive him to the emergency room, where he is admitted and diagnosed with a myocardial infarct due to a thrombus occurring in the background of severe coronary artery atherosclerosis. Although he knew about his underlying genetic disorder, he chose to ignore it and did not ever seek treatment. Of the following, what was the mode of inheritance for his underlying condition?

A. Autosomal dominant
B. Autosomal recessive
C. Co-dominant
D. X-linked
E. Mitochondrial

QUESTION 94

A 19-year-old male dies due to sepsis secondary to a pulmonary bacterial infection. At autopsy, sectioning of the lungs reveals plugging of the airways, dilation of airways, and an enlarged right ventricle with a thickened wall. Cultures of the lung grow Pseudomonas aeruginosa. Of the following, which is autopsy examination also likely to reveal?

A. Dilation of aortic root
B. Pancreatic islet metaplasia
C. Pancreatic acinar atrophy
D. Multiple liver hemangiomas
E. Patent ductus arteriosus

QUESTION 95

A 25-year-old male is seeing his physician because of an inability to have children. His wife of four years was evaluated by her obstetrician and no conditions that would contribute to infertility were identified. After a physical examination and appropriate imaging, the man is determined to have bilateral absence of the vas deferens, which was the cause of his infertility. Of the following, he most likely has a mutation of the gene for which protein?

A. Fibrillin
B. Collagen
C. Glucocerebrosidase
D. CF transmembrane conductance regulator
E. Acid lipase

QUESTION 96

A female neonate immediately after delivery is noted to have a distended abdomen. Forty-eight hours later, she has no passed meconium and has had an episode of bilious emesis. Of the following, what is a complication of her disease process that she will most likely develop during her lifetime?

A. Pancreatic adenocarcinoma
B. Congestive heart failure
C. Aortic dissection
D. Sinusitis
E. Glaucoma

QUESTION 97

A 25-year-old male is visiting his primary care physician. He has a history of numerous pulmonary infections during his lifetime, several with Pseudomonas aeruginosa as the causative agent. He has also had numerous episodes of diarrhea when not following his prescribed diet and medication regimen. Laboratory testing has revealed elevated concentrations of ALT and AST, and his visit today is to repeat this testing. He is concerned that he may be developing cirrhosis. Of the following, what is the inheritance pattern for his condition?

A. Autosomal dominant
B. Autosomal recessive
C. Co-dominant
D. X-linked recessive
E. X-linked dominant

QUESTION 98

A mother brings her child to an acute care clinic. Her and her husband delivered the child at home and have never sought medical care. The mother reports that she delivered a healthy baby boy, who was able to eat just fine; however, by about 6 months of age, her and her husband felt something was wrong. Six months later, she decided to bring her child to a doctor, as he had not talked and cannot walk. Physical examination reveals a normally developed child with pale hair and pale skin. Auscultation of the chest reveals no murmurs. Palpation of the abdomen reveals no hepatosplenomegaly. Of the following, a deficiency of which enzyme is the cause of this child’s clinical presentation?

A. CF transmembrane conductance regulator
B. Lysosomal glucosidase
C. Glucose-6-phosphatase
D. Glucocerebrosidase
E. Phenylalanine hydroxylase

QUESTION 99

A mother brings her 2-year-old son to an acute care clinic. She explains that she delivered her child at home and has never received medical care; however, her son has not gained weight as she expected, sometimes shakes, and has difficulty walking. Physical examination reveals an enlarged liver. A chest x-ray reveals a normal cardiac silhouette. Examination of the eyes reveals no abnormalities. Of the following, which enzyme is most likely deficient?

A. Glucose-6-phosphatase
B. Muscle phosphorylase
C. Lysosomal glucosidase
D. Galactose-1-phosphate uridyltransferase

QUESTION 100

A mother brings her 6-month-old male infant to the pediatrician. She reports that over the past two months, she had had increasing difficulty feeding her baby, and, despite attempts, cannot get her child to stand; she also feels her child is more floppy than he should be. Physical examination reveals an enlarged liver. A chest x-ray reveals an enlarged cardiac silhouette. The child is <10% of age for height and weight. Of the following, what is the most likely enzyme deficiency?

A. Glucose-6-phosphatase
B. Muscle phosphorylase
C. Phenylalanine hydroxylase
D. Lysosomal glucosidase
E. Glucocerebrosidase

QUESTION 101

A 12-year-old male is brought to the emergency room by his parents because of sudden onset of abdominal pain, which has not resolved over the two hours. Physical examination reveals rebound tenderness and guarding. An exploratory laparotomy reveals peritonitis associated with rupture of the descending colon. Two years ago, this child had emergent surgery to repair rupture of a mesenteric artery. The underlying genetic condition is due to a mutation in the gene for production of which type of collagen?

A. Type I
B. Type II
C. Type III
D. Type IV

Questions 86-88: Neoplasia

QUESTION 86

A researcher is working with gliomas in an attempt to understand the pathogenesis. One of her projects involves studying a mutated isocitrate dehydrogenase gene. Of the following, by which mechanism does this mutated gene promote neoplasia?

A. Production of 2-hydroxyglutarate
B. Production of a telomerase
C. Promotion of release of E2F
D. Over-production of bcl-2
E. Under-production of bcl-2

QUESTION 87

A medical student is on a 4th year pathology elective and is sitting at the microscope with their attending physician looking at a biopsy of a cervix. The pathologist points out areas of dysplasia to the medical student. The finding of which of the following features would indicate carcinoma was present within the areas of dysplasia?

A. Markedly increased number of mitotic figures
B. Increase in nuclear:cytoplasm ratio
C. Separate nests of squamous cells resembling the dysplastic cells, but in the dermis
D. Prominent new blood vessel formation
E. Dysplastic cells extending from the basement membrane to the apical surface

QUESTION 88

A pathologist is examining a prostate biopsy. Focally, within the biopsy is a small cluster of tissue characterized as small glands that are back-to-back, as opposed to the normal prostatic glandular tissue that is characterized by large glands with intervening space. The pathologist determines that the focus of cells is neoplastic. Of the following, what would be the best name for this focus of neoplastic cells?

A. Squamous cell carcinoma
B. Adenocarcinoma
C. Adenosarcoma
D. Leiomyosarcoma
E. Teratoma

Questions 74-85: Neoplasia

QUESTION 74

A pathologist is examining a surgically removed mass under the microscope. Of the following, which feature would indicate the mass was malignant?

A. Necrosis
B. A high mitotic rate
C. Nuclear pleomorphism
D. Focal calcification
E. Invasion of surrounding tissue.

QUESTION 75

Prior to an elective laparoscopic cholecystectomy, a 54-year-old male has a chest x-ray as part of his pre-operative work-up. The x-ray reveals a mass in the left lung, which is subsequently surgically excised. The pathologist examining the tissue notes it to be well-circumscribed, firm, and gray-white. Microscopically, he sees disorganizing but otherwise benign-appearing hyaline cartilage. Of the following, what is the best term to describe this mass?

A. Adenoma
B. Chondrosarcoma
C. Hamartoma
D. Choristoma
E. Hyalinoma

QUESTION 76

A pathologist is examining a repeat cervical biopsy from a 25-year-old female with a history of multiple sexual partners. She is positive for HPV16. Previous biopsies have revealed mild to moderate dysplasia. Of the following, which microscopic finding would indicate that carcinoma has developed within the dysplastic epithelium?

A. Marked disorganization of cellular maturation from basal to apical layers
B. Numerous mitotic figures throughout the epithelium
C. Hyperchromatic nuclei of various sizes throughout the epithelium
D. Sloughed outer layer of the epithelium
E. Nests of atypical epithelial cells within the superficial dermis

QUESTION 77

A 23-year-old male develops abdominal pain. A CT scan reveals a mass in the liver. A surgical resection is performed. Microscopic examination of the mass by the pathologist reveals a diagnosis of metastatic osteosarcoma. Subsequently, radiologic examination of the right knee reveals a mass. Of the following, which route most likely allowed the neoplasm to spread from the knee to the liver?

A. Spread of tumor cells through the lymphatics
B. Spread of tumor cells through the blood
C. Spread of tumor cells along the surface of nerves
D. Invasion and growth along the lymphatics
E. Invasion and growth along the blood vessels

QUESTION 78

A neuropathologist is examining a biopsy of a brain tumor at frozen section. Features consistent with a glioblastoma are identified. Molecular analysis of the tumor reveals over-expression of the PDGF gene. This molecular abnormality contributed to which of the following mechanisms by which this tumor developed?

A. Evasion of immune surveillance
B. Sustained angiogenesis
C. Evasion of apoptosis
D. Self-sufficiency for growth signals
E. Insensitivity to growth-inhibitory signals

QUESTION 79

A young woman is diagnosed with breast cancer after a biopsy of a suspicious mass that had been detected by mammography. The pathologist confirmed the diagnosis of invasive ductal carcinoma and molecular analysis revealed that the tumor was HER2 positive. She received chemotherapy, including anti-HER2 antibodies. Her molecular abnormality contributed to which of the following mechanisms by which this tumor developed?

A. Evasion of immune surveillance
B. Sustained angiogenesis
C. Evasion of apoptosis
D. Self-sufficiency for growth signals
E. Insensitivity to growth-inhibitory signals

QUESTION 80

A large medical center that conducts molecular analyses of neoplasms for various small hospitals in the area, specializing in no specific tumor type, conducts a statistical analysis of their last 1000 tumors. Of the following, a mutation of which gene did they see most commonly?

A. ABL
B. MYC
C. ERBB1
D. RAS
E. PTEN

QUESTION 81

A 53-year-old male with a 45 pack-year smoking history is diagnosed with pancreatic adenocarcinoma during the work-up of prolonged and unexplained abdominal pain. Molecular analysis of the tumor reveals a mutated RAS gene. Of the following, what was the most likely mechanism by which this mutation contributed to the development of the tumor?

A. Pre-mature hydrolysis of ATP
B. Impaired hydrolysis of ATP
C. Pre-mature hydrolysis of GTP
D. Impaired hydrolysis of GTP

QUESTION 82

A pathologist is examining a tumor removed from the left testis of a young boy. Within the tumor, the pathologist identifies squamous epithelium overlying sebaceous glands, hyaline cartilage, neural tissue, and hepatocytes. Of the following, what is the correct name for this tumor?

A. Hamartoma
B. Carcinoma
C. Sarcoma
D. Teratoma
E. Choristoma

QUESTION 83

A pathologist is examining a malignant neoplasm of the lung. Molecular analysis reveals that the tumor has a mutation of the RB gene. Of which of the following mechanisms did the mutation present contribute to the development of the neoplasm?

A. Self-sufficiency in growth signals
B. Insensitivity to growth-inhibitory signals
C. Altered cellular metabolism
D. Evasion of apoptosis
E. Limitless replicative potential

QUESTION 84

A researcher is studying the role of apoptosis in breast tissue following a period of lactation after the birth of a child. In their study, they wish to promote apoptosis in samples of lactating breast tissue to study its effects. Promotion of transcription of which of the following genes would best bring about their desired effects?

A. RB
B. Cyclin D
C. MYC
D. TP53
E. GADD45

QUESTION 85

A research oncologist is studying the Warburg effect in neoplastic cells obtained from an individual with small cell carcinoma of the lung. Given that the Warburg effect is present in this cell population, the breakdown of glucose to which of the following substances is expected to be greater than expected?

A. Lactose
B. Water and oxygen
C. Glycine
D. Reactive oxygen species
E. Triglycerides

Question 65-73: Immune pathology

QUESTION 65

An 11-month-old male is brought to his pediatrician by his parents. They report that he has been pulling at his ear, what they recognize as probably an ear infection, since he has had otitis media four times before. The pediatrician decides to order laboratory tests to check for a primary immunodeficiency. Laboratory testing reveals very low concentrations of Ig in the blood, with IgG, IgM and IgA being affected. Flow cytometry of the blood reveals no B cells. Of the following, what is the most likely diagnosis?

A. Chronic granulomatous disease
B. Selective IgA deficiency
C. Leukocyte adhesion deficiency
D. X-linked severe combined immunodeficiency
E. X-linked agammaglobulinemia

QUESTION 66

A 14-month old male is brought to the pediatrician by his parents because he has been coughing up a thick green mucous. A chest x-ray reveals consolidation of the lower lobe of the right lung. Three months ago, he had an episode of otitis media and seven months ago, he had been diagnosed with Haemophilus influenzae pneumonia. Flow cytometry of the blood reveals an absence of B cells. Of the following, which is he most likely to develop in the future?

A. Disseminated Candidiasis
B. Infectious mononucleosis due to Epstein-Barr virus
C. Giardia lamblia induced diarrhea
D. Aspergillus pneumonia
E. Mycobacterium tuberculosis pneumonia

QUESTION 67

A 23-year-old female is in a motor vehicle accident and fractures her femur. At the hospital, she requires a blood transfusion in the emergency room, prior to surgery. Her only past medical history is recurrent sinusitis and a past skiing accident that caused a significant laceration, with blood loss requiring transfusion. After receiving the transfusion for the femoral fracture, she develops shortness of breath and requires intubation to protect her airway. Of the following, what is her most likely underlying diagnosis?

A. X-linked agammaglobulinemia
B. Severe combined immunodeficiency
C. Ataxia-telangiectasia
D. Selective IgA deficiency
E. Wiskott-Aldrich syndrome

QUESTION 68

Over the past seven hunting seasons, a 35-year-old male has twice developed Giardia lamblia. Although he admits to routinely drinking water from streams when hunting, his physician decides to order some laboratory tests to evaluate his condition. His past medical history is significant only for the recent development of rheumatoid arthritis. He is up-to-date on his vaccinations, and post-hepatitis vaccination testing revealed normal development of protective antibodies. Laboratory testing reveals a significantly decreased concentration of IgA. Of the following, what else would laboratory testing reveal?

A. Normal IgG; Normal IgM
B. Normal IgG; Decreased IgM
C. Normal IgGl Increased IgM
D. Decreased IgG; normal IgM
E. Decreased IgGl decreased IgM

QUESTION 69

A 17-year-old female has had frequent episodes of otitis media during her lifetime as well as four serious cases of pneumonia, and one episode of Giardia lamblia induced diarrhea. During a follow-up examination after her diarrhea resolved, laboratory testing reveals decreased concentrations of IgG and IgA; however, flow cytometry reveals an increased number of CD19+ cells. Of the following, a biopsy of the gastrointestinal tract is most likely to reveal?

A. Amoeba
B. Hyperplastic follicles
C. Hypoplastic follicles
D. Amyloid deposition
E. Acute colitis

QUESTION 70

A 6-year-old male is being seen by his pediatrician for a routine follow-up visit. He has had difficulty learning to walk, has had two episodes of pneumonia requiring hospitalization, and recently his parents have noticed small red nodules on his right eyelid and left ear. Laboratory testing reveals a decreased concentration of IgA. Of the following, what is the inheritance pattern for his condition?

A. Autosomal dominant
B. Autosomal recessive
C. Co-dominant
D. X-linked
E. Mitochondrial

QUESTION 71

A 13-year-old female is having surgery to remove CNS lymphoma that was diagnosed after she had a seizure. During her life, she has had difficulty walking and her speech has of lately been slurred, which was not attributed to the cerebral neoplasm. Physical examination prior to the surgery reveals numerous small red nodules on her body, including her eyelids, antecubital fossa, and sides of the neck. Of the following, laboratory testing would reveal an elevated concentration of which substance, which is used for diagnosis of her underlying condition?

A. IgA
B. IgG2
C. Alpha-fetoprotein
D. Alanine aminotransferase
E. Creatinine kinase

QUESTION 72

A 2-year-old male is seen by his pediatrician for follow-up of his chronic disease process. He receives daily doses of calcium and vitamin D and, shortly after birth, underwent heart surgery to repair his Tetralogy of Fallot. Of the following, what is the location of the deletion causing his condition?

A. 22q11
B. 22q12
C. 21q11
D. 21q12
E. 11q22
F. 11q12

QUESTION 73

At 36 hours after birth, a term female infant is noted by her mother to have muscular spasms. A physician orders stat testing for calcium. The calcium concentration is low. Following the resolution of the muscular spasms, an echocardiogram is performed, which reveals a ventricular septal defect, right ventricular hypertrophy, and an incomplete obstruction of the right ventricular outflow tract Flow cytometric analysis of the blood reveals normal numbers of B lymphocytes, but absent T lymphocytes. A lateral chest x-ray would reveal which of the following?

A. Scoliois
B. Thymic aplasia
C. Thymic hyperplasia
D. Consolidation of one lobe of a lung
E. Absence of the aorta

Questions 58-64: Hemodynamics

QUESTION 58

A medical student is watching a presentation on Budd-Chiari syndrome, which is due to thrombosis of major hepatic veins. During the presentation, a pathologist shows a slide with a microscopic image of the liver. Changes consistent with which of the following processes would be present around the central veins?

A. Acute congestion
B. Chronic congestion
C. Acute hyperemia
D. Chronic hyperemia

QUESTION 59

During their rotation in the emergency room, on one day, a medical student saw a patient with prominent swelling of their left upper extremity and a light red-pink discoloration and a patient with prominent swelling of both lower extremities and a dark red-blue discoloration. Of the following, the concentration of which compound accounts for the color difference?

A. Carbon dioxide
B. Oxygen
C. Nitrogen
D. Carbon monoxide
E. Methemoglobin

QUESTION 60

A 64-year-old male with congestive heart failure due to end-stage systemic hypertension presents to his primary care physician. Physical examination reveals rales and pitting edema of the lower extremities. Of the following, which mechanism was most responsible for his physical findings?

A. Increased hydrostatic pressure
B. Decreased hydrostatic pressure
C. Increased plasma osmotic pressure
D. Decreased plasma osmotic pressure

QUESTION 61

A 34-year-old pregnant female is brought to the emergency room by her husband because she suddenly became short of breath and developed chest pain. A spiral CT scan reveals a peripherally located thromboembolus in the lower lobe of her left lung. Physical examination revealed that the left thigh and calf had a greater diameter than the right thigh and calf. Of the following, which mechanism was responsible for the physical examination findings?

A. Increased hydrostatic pressure
B. Decreased hydrostatic pressure
C. Increased plasma osmotic pressure
D. Decreased plasma osmotic pressure

QUESTION 62

A 41-year-old alcoholic male presents to an acute care clinic complaining that his stomach has been getting larger lately. Physical examination reveals a fluid wave, consistent with ascites. Of the following, which two mechanisms are most responsible for his physical examination findings?

A. Increased hydrostatic pressure; increased plasma osmotic pressure
B. Increased hydrostatic pressure; decreased plasma osmotic pressure
C. Decreased hydrostatic pressure; increased plasma osmotic pressure
D. Decreased hydrostatic pressure; decreased plasma osmotic pressure

QUESTION 63

A 42-year-old female is presenting to her general surgeon for a visit after having undergone a partial mastectomy and lymph node dissection of the right breast for the treatment of invasive ductal carcinoma. The surgeon notes during physical examination and as reported by the patient that her right arm and forearm are swollen. Of the following, which is the most likely mechanism responsible for this physical examination finding?

A. Increased hydrostatic pressure
B. Decreased hydrostatic pressure
C. Increased plasma osmotic pressure
D. Decreased plasma osmotic pressure
E. Localized sodium retention
F. Lymphatic obstruction

QUESTION 64

During a wrestling competition, an amateur wrestler, while dead-lifting 300 lbs, develops tiny pinpoint red dots on his eyelids. Of the following, which would be the best descriptive term to use for these lesions?

A. Hemorrhage
B. Purpura
C. Ecchymoses
D. Bruising
E. Petechiae

Questions 46-57: Inflammation and repair

QUESTION 46

A 1-year-old child has had recurrent skin infections. Laboratory testing has revealed elevated white blood cell counts. Molecular testing revealed a defect in the β subunit of CD18 on leukocytes. Of the following, which phase of the neutrophil response during inflammation was most affected?

A. Margination
B. Rolling
C. Adhesion
D. Migration through the endothelium
E. Chemotaxis

QUESTION 47

A 13-year-old male was diagnosed just shortly after birth with tetralogy of Fallot following auscultation of a murmur. At 4 days of age, laboratory investigation of jerking motions of his lower extremities revealed a calcium concentration of 4.6 mg/dL. Of the following, fluorescence in-situ hybridization (FISH) would most likely reveal a deletion of?

A. 21q11.1
B. 21q11.2
C. 22q11.1
D. 22q11.2
E. Y chromosome

QUESTION 48

A 13-year-old girl is roller skating with her friends when a dog runs out in front of her, causing her to crash, during which time, she strikes her left elbow hard on the sidewalk. She returns home and tells her mother what she did. Her mother notices that her left elbow has begun to swell. Of the following, which mediator was most responsible for this change?

A. Histamine
B. CD11a/CD18
C. Leukotriene B4
D. Toll-like receptor
E. C3b

QUESTION 49

A 13-year-old girl has been having a cough and fever for the last four days, and over the last day developed some difficulty breathing. Her parents did not take her to the emergency room, because they knew a cold was going around. In the morning, they found her unresponsive in her bed. An ambulance was called, but she was pronounced dead. An autopsy was performed, and in the left pleural cavity was a thick white-yellow cloudy fluid substance. Microscopic examination of the lungs confirmed a lobar pneumonia. Of the following, which term best described the substance in the left pleural cavity?

A. A serous exudate
B. A purulent exudate
C. A serous transudate
D. A fibrinous transudate
E. A purulent transudate

QUESTION 50

A researcher wants to develop a drug that decreases the acute inflammatory response. The hypothesis is that if neutrophils can be prevented from contacting the endothelium that the acute inflammatory response can be blunted, which may help some patients. Of the following, which mediator would be the best target for the drug?

A. CD31
B. LFA-1
C. P-selectin
D. ICAM-1
E. Toll-like receptor

QUESTION 51

Two individuals rescued from a house fire are brought to the emergency room. One sustained a large bruise on the left forearm when a beam collapsed and struck them and the other sustained 9% body surface area burns on their trunk. The bruise swells for a short period of time and then the swelling dissipates; however, the burn continues to weep fluid, requiring frequent dressing changes over the course of two weeks. What did the burn victim sustain that the contused individual did not?

A. Rapid release of histamine
B. Delayed release of serotonin
C. Activation of CD31
D. Bacterial superinfection
E. Endothelial necrosis

QUESTION 52

A pathologist is examining sections from the heart of an individual who sustained an acute myocardial infarct and subsequently died. In the section, the pathologist notes coagulative necrosis and a brisk neutrophilic response, with large aggregates of neutrophils scattered throughout the tissue. No macrophages are identified and all neutrophils appear intact. Of the following, what was the time frame between the occurrence of the infarct and the individual’s death?

A. 5 seconds
B. 15 minutes
C. 3 hours
D. 1 day
E. 1 week

QUESTION 53

A pathologist is examining a section of gallbladder that was resected from a patient having abdominal pain. Of the following, which would indicate the patient had chronic cholecystitis instead of acute cholecystitis?

A. Neutrophilic infiltrate
B. Edema of the wall of the gallbladder
C. Dilated blood vessels
D. New blood vessel formation

QUESTION 54

A 52-year-old male is found dead in his house during a welfare check by police. At autopsy, he is found to have an organizing thrombus in the left anterior descending coronary artery and a corresponding infarct of the anterior wall of the left ventricle. Microscopic examination of the infarct reveals some neutrophils, but also a prominent number of macrophages, which have engulfed necrotic debris and degenerating neutrophils. Which of the following mediators activated the macrophages?

A. IL-13
B. IFN-γ
C. Eotaxin
D. TGF-β
E. C5a

QUESTION 55

A pathologist is examining a lung biopsy in a patient suspected of having tuberculosis. Numerous granulomas are identified throughout the biopsy. An acid-fast stain reveals occasional acid-fast bacilli, consistent with tuberculosis. Of the following, what did every granuloma have?

A. Giant cells
B. A fibrous rim
C. A rim of lymphocytes
D. Central necrosis
E. Epithelioid histiocytes

QUESTION 56

A 19-year-old female presents to an acute care clinic with complaints of fever, chills, and a productive cough that has been lasting for 3 days. An x-ray reveals consolidation of the lower lobe of her left lung. A diagnosis of lobar pneumonia is made. Laboratory testing reveals a white blood cell count of 18,000 cells/mL. Which of the following mediators was most responsible for her clinical presentation?

A. IL-1
B. IL-2
C. IL-3
D. IL-4
E. IL-5

QUESTION 57

A 22-year-old male slides into the plate during a league softball game and scrapes his left knee. Penetration through which of the following layers indicates that he is most likely to develop a scar?

A. Stratum corneum
B. Stratum granulosum
C. Stratum spinosum
D. Stratum basale
E. Basement membrane